James Reilly (Dublin North, Fine Gael)
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I move:

That Dáil Éireann,

noting the failure of the Government to implement the recommendations of the Pollock report;

recognising the serious deficit in isolation units and the shortage of specialist cystic fibrosis staff;

noting the failure of the Government to secure funding for the implementation of the recommendations of A Vision for Change;

acknowledging that mental health services remain chronically understaffed, under resourced and inaccessible, and

noting the imminent threat to critical frontline hospital services in the north east;

calls on the Government to:

deliver on its commitment to develop adequate cystic fibrosis services;

fulfil its promise to implement the recommendations of A Vision for Change;

request an urgent report from the Health Service Executive on any proposals to reduce frontline services throughout the country;

to ensure that, at a time when an additional €1 billion was allocated to the HSE, frontline services are not further reduced; and

fulfil its commitment to deliver an additional 3,000 public-only hospital beds.

I wish to share time with Deputies Alan Shatter, Denis Naughten, Deirdre Clune, Tom Hayes and Olwyn Enright.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

James Reilly (Dublin North, Fine Gael)
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I welcome the Minister of State at the Department of Health and Children, Deputy Devins, and express my disappointment that the Minister, Deputy Harney, cannot be present. This is a very important debate and I find it extraordinary that she is not in the country when we are discussing health services that can be a matter of life or death for many citizens, particularly young people with cystic fibrosis.

In recent weeks, we have all heard young cystic fibrosis sufferers bravely describe on national radio and in the national papers the deficiencies in services for cystic fibrosis patients and the unacceptable conditions they have been exposed to in our hospitals. It is appalling that these brave young people have to resort to the national airwaves and newspapers to highlight the difficulties and dangers they face in the hope that they may force the changes that will give them a fighting chance — this is all they seek — to achieve the life expectancy of their fellow sufferers in Northern Ireland, Britain and the rest of Europe. I commend Joe Duffy of "Liveline" for highlighting this matter and giving it airtime.

A similar media furore ensued, almost three years ago to the day, when the shocking findings of the Pollock report where published. Dr. Pollock found that people with cystic fibrosis were being treated in facilities that were understaffed and dangerous. How little has changed. In response to the Pollock report, the Health Service Executive established a multidisciplinary working group to report on cystic fibrosis services nationally. Although the group has concluded its work, its recommendations have not been published to date, cystic fibrosis services remain seriously understaffed and patients face the same difficulties in accessing safe services that they faced some years ago.

The facts remain that more than 83% of sufferers have not seen any significant improvement in the treatment levels of adults with cystic fibrosis since the Pollock report was published. There are no dedicated adult or paediatric cystic fibrosis beds in the country and every time a patient waits in an accident and emergency unit or is treated in an open ward, he or she risks contracting a potentially life-threatening infection. Cystic fibrosis patients rely on the health service to keep their condition under control. The lack of isolation facilities, both for outpatients and inpatients, poses a most serious risk of cross-infection, leaving cystic fibrosis patients vulnerable to contracting MRSA and other potentially life-threatening infections. The Minister of State knows this well because he is a doctor.

Patients are getting sicker in hospital and are spending longer in recovery because they are being treated in dangerous facilities. This is why their life expectancy is ten years less than in Northern Ireland and Great Britain. It is disappointing that so little has changed three years after the publication of the Pollock report. The only way to improve mortality statistics for people with cystic fibrosis is to protect them from cross-infection by treating them in isolation facilities that minimise cross-infection from other patients.

Under significant pressure, the HSE has reluctantly decided to fast-track the development of St. Mark's Ward in St. Vincent's Hospital to provide six single rooms within the next ten to 18 weeks and an additional eight single rooms by the end of the summer, resulting in a total of 14 — that is if we can believe its promises. It has broken so many in the past. Although the promised beds are welcome, they are insufficient, considering there are currently 18 cystic fibrosis inpatients in St. Vincent's Hospital and ten on the waiting list. This requires a total of 28 rooms. We are deficient before we even begin.

I am sure the Minister can understand our scepticism when we are offered promises and assurances about the delivery of projects, particularly within the health service. In 2002, we were promised an additional 3,000 hospital beds but we still do not have them. Instead, there is now talk of pulling 4,000 beds out of the system. We were promised a permanent end to waiting lists in our hospitals by 2004 but this never happened. In 2002, we were promised that full medical card eligibility would be extended to 200,000 people but this never happened either. Can the Minister or the Minister of State, on her behalf, give an unequivocal guarantee to people with cystic fibrosis that six single rooms will be available for use by the end of April 2008 and that an additional eight rooms will be delivered by the end of August 2008? Will these beds be ring-fenced for cystic fibrosis patients or will they be available to all respiratory patients? I doubt that the Minister, who is not present, will make this commitment, considering that she told the House last week that she is terrified of giving deadlines.

Considering that 20% of the 2006 budgetary allocation and all of the 2007 allocation remain unspent, one must ask when the recruitment process for specialist staff will be completed. It was stated recently that 80% of the appointments have been made or advertised. Talk about weasel words and doublespeak.

With over 1,100 cystic fibrosis patients, Ireland has the highest incidence of cystic fibrosis in the world. It is unacceptable that the average life expectancy for a cystic fibrosis patient in Ireland is the lowest in western Europe and that people with cystic fibrosis in Northern Ireland can expect to live ten years longer than those living in the Republic. Northern Ireland is a mere 40 minutes up the road. These appalling statistics are a damning indictment of our health service.

It is inexcusable that we have no specialist unit, that money allocated in 2006 and 2007 remains unspent, that proper home-care support to prevent hospitalisation is not available and that we have not made any high-frequency oscillating vests available to cystic fibrosis sufferers. These vests are not suitable for all cystic fibrosis sufferers but we should surely have an assessment system in operation to make them available to those they would help. We could do this immediately and we do not need to erect buildings to do so. Some people in Kilkenny have availed of the vests. It is inexcusable that the HSE working group report remains unpublished, that we have no indication how neonatal screening will be introduced or the timescale and, most important, that we have no isolation beds and en suite facilities for cystic fibrosis sufferers.

It is not just disappointing that services for cystic fibrosis patients are far below internationally acceptable standards and that patients must wait until 2011 for the new single-room block at St. Vincent's Hospital. One should forget about 2010 because the contracts are not being issued until the end of the year, as Deputy Shatter pointed out at the end of last week. This means the building will not be finished until late 2010 and will not be commissioned until well into 2011. It is disgraceful that we continue to imperil the lives of cystic fibrosis sufferers due to lack of political will to implement the clearly defined changes I have mentioned. The Department of Health and Children is already aware of a company in Tyrone that will build a modular unit in four months rather than two years and whose services have already been availed of in the Mater, Beaumont and Temple Street hospitals. The technology exists and all that is required is the political will.

I want to touch on mental health services and the lack of funding in this regard. My colleague, Deputy Neville, will also address this matter. It is totally unacceptable that funding allocated for the implementation of the recommendations of A Vision for Change is being diverted to other areas. The Irish Mental Health Coalition recently revealed that almost half of the €50 million allocated for the implementation of A Vision for Change in 2006 and 2007 was hived off to meet current spending deficits in mental health services. This is a downright betrayal of patients and a U-turn on the Government's own policy. In this regard, we have heard more weasel words.

While speaking on "Prime Time" some weeks ago, the Minister of State, Deputy Devins, was unable to answer how much of the €50 million was actually spent on mental health services. Does this sound like a Minister of State who is engaged and in control of his brief? Is this what we should expect from a Minister of State who has primary responsibility in this area? The Government cannot pretend that it did not know the funding allocated over the past two years for the development of mental health services was not delivered. Blaming the Health Service Executive for this is just not an option.

In January, the Irish Psychiatric Association published a report entitled Lie of the Land which revealed that money realised from the sale of assets in the mental health service was not being ring-fenced for reinvestment in the psychiatric services. Last week, Deputy Devins stated he had asked the Health Service Executive to prepare a report on The Lie of the Land in so far as it relates to the disposal of assets over the past two years. Why only the past two years?

In 1984, a document entitled Planning for the Future, a mental health document——

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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Because A Vision for Change only came into operation——

James Reilly (Dublin North, Fine Gael)
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I am sorry but the Deputy should not interrupt.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The Deputy asked a question and I was answering it.

James Reilly (Dublin North, Fine Gael)
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Section 15.11 of Planning for the Future, published in 1984, was to be Government policy. The specified funds were to be ring-fenced for psychiatric and mental health services, acknowledging the fact that these services represent the Cinderella of our health service and always have done. Under this Government, they remain so, and if it is left in power, this will always be the case. I hope the day is not too far away on which we will have a change of Government, rather than a change of heart on the part of the Minister of State, to the benefit of those who suffer from mental illness.

Perhaps the Minister of State will let us know when the Minister expects to receive the report on Lie of the Land and if it will be publicly available. The proceeds of these sales are not being used exclusively for the provision of mental health services. The Comptroller and Auditor General may have questions to ask about the value for money achieved in regard to certain disposals of psychiatric and mental health institutions. All this is in contrast to the assertion of the former Minister of State, Mr. Tim O'Malley, in the Irish Examiner of Tuesday, 10 August 2004 that despite opposition from the Department of Finance, he had "secured Government assurances that all proceeds from the sale of lands would be ring-fenced for funding of mental health services".

Will the Minster of State explain why the Government failed to secure the 2008 allocation of €25 million needed for the implementation of A Vision for Change? This speaks volumes about the Government commitment to psychiatric services; it is all vision and no change. All of us are aware of the need for more funding. Last year, the Inspector of Mental Health Services, Dr. Susan Finnerty, reported that less than 10% of psychiatric catchment areas were able to offer a range of services to people with mental health problems. She expressed concern that there is no coherent plan for the development of services in the next five years.

An independent monitoring group chaired by Dr. Ruth Barrington reviewed A Vision for Change and found "little evidence to show a systematic approach to its implementation in the first year". The group noted that there was no implementation plan with objective action milestones or deadlines, the absence of which is impeding progress. Meanwhile, the Chief Executive Officer of Mental Health Ireland, Mr. Brian Howard, catalogued a decline in services where, three years ago, there had been 11 suicide resource officers in the State, whereas now there are five. This decline in service is all the more galling given that Ireland has the fifth highest youth suicide rate among 15 to 24 year olds in the EU.

Some weeks ago, the Ombudsman for Children, Ms Emily Logan, criticised the continuing use of adult psychiatric wards for the treatment of children, with children admitted to adult psychiatric wards on more than 200 occasions between December 2006 and December 2007. In 2006, 3,000 children and adolescents waited, on average, 15 months for assessment, with some families waiting as long as four years. Waiting lists were even longer in 2007, with 3,598 children waiting for assessment, one third of whom waited for more than 12 months. In 2008, with no money allocated for the implementation of A Vision for Change, the situation is likely to deteriorate.

The case of the planned psychiatric unit at Beaumont Hospital is an example of the decline in services. It was originally promised more than 20 years ago and was subsequently built. It was used, however, as an overflow area for patients from the medical and surgical wards and now lies full of equipment. A new unit was subsequently proposed and much time and money was spent on its planning. It was sent out to tender in 2005. We have since discovered, however, that a new private co-located hospital is to be built on part of the site. So much for a commitment to mental health services. It is a case of get back to the end of the queue for mental health patients. In the eyes of the Government, which has presided over the health services for the past ten years, they are the least worthy patients. This is because they are the most vulnerable and represent the least threat.

Patients in north and north-east Dublin are still being admitted to St. Ita's Hospital, where there are 24 beds, 23 of which are in an open dormitory. Twenty-three acutely disturbed patients, many of whom are psychotic, are accommodated in a dormitory with only three feet between beds, in a building that was constructed more than 30 years ago. These are Ceausescu-like conditions. Many patients in St. Ita's are kept in chemical strait-jackets and drugged up to their eyeballs, a situation with which most psychiatrists there are unhappy.

I heard recently of a woman in that unit who was assaulted by another patient who had been out on a day pass. This other patient returned to the ward, took her pillow and tried to suffocate the woman in question. It is a tribute to the staff of these units that more patients have not been seriously harmed or even killed. This is no way to treat the most vulnerable in society in what is supposedly the second wealthiest country in the western world. Despite all this, I understand St. Ita's Hospital is operating a two for one staffing policy, that is, for every two members of staff let go, only one is replaced.

There is no mental health service for 16 to 18 year olds in the Swords area. Adult psychiatrists do not feel competent to deal with them and the services for children have insufficient resources to do so. The mental health clinic in Balbriggan is an old prefabricated building with fungus growing on the walls. What would the Health Information and Quality Authority have to say about nurses taking blood from patients in such conditions?

This is how people are being treated in 2008. As she does with every other aspect of the health service, the Minister pays little other than lip service to mental health provision. It is one of the great scandals of the 21st century that some of the most vulnerable in our society are treated in this way. Yet the Government continues to preside over this system. It is time the Minister lived up to her promises instead of consigning the Government's mental health strategy to the rubbish tip.

Mental health services are not the only services that continue to struggle. I was alarmed last week to read an internal HSE memo planning wholesale cutbacks in front-line health services in the north east, including a 25% reduction in orthopaedic and elective surgery in Our Lady's Hospital, Navan, a scaling back of elective surgical activity in Louth County Hospital, a reduction in outpatient clinics in Our Lady of Lourdes Hospital, Drogheda, and elsewhere, elective surgery to take place only four days a week within the Cavan-Monaghan hospital group, the closure of ten beds at Monaghan Hospital and so on. Tallaght hospital is in serious difficulty. The €20 million taken from its budget last year will not be replaced. In addition, it faces a fine of €2.1 million. It is outrageous that the people of Tallaght should suffer because of the ineptitude of the management. In addition, the HSE midland area plan involves a reduction in expenditure of €5 million.

It seems the new year is beginning with the same swingeing health cutbacks that took place in the last months of 2007 and which we were told were only a temporary measure. This should be no surprise given that we were originally told, in the first half of 2007, that there would be no cutbacks. This HSE memo is further evidence that the teamwork implementation project, the details of which were leaked on 14 May last year, is being put into practice. This scheme exposed the Minister's plan to close accident and emergency departments in Monaghan and Dundalk in 2008 and Navan in 2009 on the basis that such actions would present "major opportunities for savings, efficiencies and staff redeployment". Nowhere is there mention of patient welfare.

While the Minister pays lip service to putting patients first, it is telling that both these HSE documents refer to cost efficiencies only and not to patient care. Hospital management is responsible for the hospital budget and it should take the hit rather than patients. Members of management take fat increases in salaries as they try to convince us that they are doing a great job. The reality is that the service is deteriorating. There are no beds for psychotic patients. There was no bed for 39 year old Beverly Seville-Doyle, a diabetic mother of three who died alone in a toilet in an accident and emergency unit at 3 a.m. There is no bed for the mother of seven with a probable brain tumour who must sit at home having mini-seizures. Up to 400 patients wait on trolleys in hospitals throughout the State. The shameful list goes on.

While there are plans to open a medical assessment unit at Our Lady's Hospital, Navan, and elsewhere, the true objective is to strip out services before they are replaced. Last week, I received a copy of a letter by Dr. Finbar Lennon, a consultant at Our Lady of Lourdes Hospital, Drogheda, outlining his view that the hospital is not capable of dealing with the load that will be placed on it. The latest we hear is that the HSE is €370 million short on its estimated expenditure for 2008 before the year has even begun. It is frightening that its solution is to cut back patient services rather than improve efficiencies in its management structures.

The problem with the health service in general is that we have insufficient capacity to deal with the demand. The solution is equally clear. First, we must increase capacity. This can be done by making better use of the beds we have in hospitals. I have alluded numerous times to the 57,000 bed days lost between the Mater and Beaumont last year alone, the equivalent of a 150-bed hospital. These patients could be treated in the community if facilities were available, including physiotherapy, occupational therapy and speech and language therapy. We must also increase capacity by providing more beds. There is no getting away from this requirement. The consulting firm employed by the HSE has told the Minister there is a shortfall of 1,200 beds and that this situation will deteriorate unless we change the way we do business.

The second part of the solution is to reduce demand through prevention. I have called before for the introduction of an age appropriate annual check-up for every man, woman and child. This would allow for the earlier detection and treatment of disease and help prevent costly complications. We must work to prevent the incidence of illnesses such as diabetes and heart disease through education, dietary advice and regular contact between patient and GP. This approach will take time to yield results, but for every euro spent on prevention, there is a €20 saving in terms of treatment costs avoided. The Government must have the political courage and vision to implement such an approach immediately because the benefits will be some time in coming.

The health service has been characterised by failure after failure. The HSE must report immediately on the proposal to reduce front-line services. I ask that the Minister fulfil her Government's promise to implement the recommendations of A Vision for Change, that she request the urgent report from the HSE on the proposal to reduce frontline services, that she ensures, at a time when an additional €1 billion is available to the HSE, that frontline services are not further reduced, that she fulfils her commitment on hospital beds and medical cards, that she gives us a site location map for the new psychiatric unit at Beaumont Hospital to replace the unit in St. Ita's for which we have waited over 20 years, and that she gives us the isolation units and isolation beds for our cystic fibrosis suffers so that they have a fighting chance to live as long as their counterparts on the other half of this island, which is all they want.

Alan Shatter (Dublin South, Fine Gael)
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It is regrettable the Minister for Health and Children is not here. The Minister of State, Deputy Devins, might confirm whether her absence is due to her going to the Super Bowl in the United States. I would have thought a debate in this House on the problems within our health service, particularly those highlighted by my colleague, deserves greater priority than it is being given.

I wish to concentrate on cystic fibrosis patients and to add to what my colleague, Deputy Reilly, has said. The manner in which we have treated cystic fibrosis patients and their parents and families is a national disgrace and scandal. There are over 1,100 patients with cystic fibrosis in Ireland and, as has been said, the highest proportion of patients per head of population of any other country in the world. It is a damning indictment of Fianna Fáil-Progressive Democrats health policy over the past 11 years that a person born in this State with cystic fibrosis has an average life expectancy which is ten years less than a patient in similar circumstances suffering from cystic fibrosis anywhere in the United Kingdom or in Northern Ireland.

At a time of unprecedented economic success, the Government has failed abysmally to implement the recommendations of the Pollock report published three years ago. This month we celebrate the third anniversary of the publication of that report. It recommended urgent action to address the dangerously inadequate staffing levels; the designation of a small number of adequately staffed fully supported cystic fibrosis centres throughout the country; that adult provision outside Dublin should be developed urgently to create a balanced service with broad geographical coverage, thus reducing the excessive burden on St. Vincent's Hospital; that all beds for cystic fibrosis patients should be in single en suite facilities to prevent cross-infection; that links between the adult and children's units be strengthened; that a microbiology reference laboratory be established — some have proposed that it be established in Tallaght; and that we have neonatal screening programmes. Few, if any, of these recommendations have been implemented in the three years since the publication of the report.

Some €4.7 million in funding was set aside in the 2006 budget, announced in November 2005, for the recruitment of 57 additional specialist staff. Some 20% of the 2006 allocation remains unspent and specialist staffing levels remain inadequate. Budget 2007 allocated an additional €2 million to allow for the recruitment of an additional 30 medical posts. However, according to Godfrey Fletcher, the CEO of the Cystic Fibrosis Association of Ireland, there is no evidence that this funding is being used. The HSE working group on cystic fibrosis, established in May 2005, finished its work in August 2006. Over a year later, it has not published its findings. What is the reason for the suppression of this report?

As is the position in adult hospitals, many of the cystic fibrosis units, including those relating to paediatrics and the clinic in Crumlin Children's Hospital, do not have ring-fenced, dedicated inpatient wards with single en suite rooms to prevent cross-infection. There is a need to urgently establish such facilities in tandem with providing them for adult patients who suffer from cystic fibrosis. This need was highlighted as recently as Thursday last by Dr. Gerard Canny of the cystic fibrosis unit in Crumlin Children's Hospital in a letter to The Irish Times. When I raised it in the Dáil last Thursday afternoon, the Minister had no short-term solutions to provide the facilities needed for children suffering from cystic fibrosis.

It is appalling that neither the HSE nor the Department of Health and Children urgently responded to the need for single en suite hospital facilities for adult cystic fibrosis patients until the publicity of recent weeks highlighting the gross inadequacy of existing services and the extent to which lives are being placed at risk. For cystic fibrosis patients, this is not a debating issue; it is a life and death one. It is a life and death issue which the Government has to date chosen to ignore.

The promised new ward to be built in St. Vincent's Hospital, contrary to the dishonest perception created by the Minister, will, as Deputy Reilly said, take four years to come on stream. An announcement was made that construction would start this year. When I questioned the Minister last Thursday, it emerged that construction would start in November or December 2008. That was the January 2008 position. Construction will take 24 months and thereafter the hospital wing constructed will have to be commissioned. We are four years away from that facility.

It is also not good enough that we do not yet have neonatal screening of all babies at birth for cystic fibrosis. This has been provided for all newborn babies in Northern Ireland since 1983, some 25 years. In the past two weeks, the HSE intimated that there was a possibility that it would commence this year in this State. When I asked the Minister last Thursday if she could confirm with certainty that it would commence in 2008, we were told by her that she could not. The benefit of neonatal screening is that cystic fibrosis is detected early and necessary treatments are provided early. In this country, the average age of detection for children is two years which means treatment starts later than is desirable.

It is truly nauseating that, in its proposed amendment to the Fine Gael motion, the Government applauds itself on the services provided by it to cystic fibrosis patients. The truth is it should hang its head in shame. The truth is that not only Fianna Fáil and the Progressive Democrats, which have now been in continuous Government for almost 11 years, bear responsibility for the inadequacies in our cystic fibrosis services, but so too does the Green Party which failed to make the needs in this area a priority issue in the Agreed Programme for Government. The truth is that without the recent public furore, the 14 en suite rooms to become available in St. Vincent's Hospital this year would not have been promised or be constructed.

The tragic reality is that neither the Minister nor her immediate predecessors in the Department of Health and Children regarded the plight of cystic fibrosis sufferers as a priority. This tragic reality was cruelly expressed by the HSE, I am advised, in replies forwarded by it during the previous Dáil to questions tabled by some Members. When explaining the HSE's abject failure to provide vital services, it did so in financial terms by referring insensitively to "cost benefit analysis", by implication indicating that it would not get value for money by providing essential facilities required to extend the lifespan of cystic fibrosis sufferers and to protect them from cross-infection when admitted to hospital. It is simply not good enough.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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I welcome the motion tabled by my colleague, Deputy Reilly. As previous speakers said, Ireland has the highest incidence of cystic fibrosis in the world. The Pollock report outlined clearly what needs to be done. If anyone has any issue in regard to the needs that exist, all he or she has to do is to listen to the "Liveline" programmes of recent weeks to hear the appalling reports of people who must deal with this issue on a daily basis and how they must interact with the health service.

The basic issues which need to be addressed include single en suite rooms to prevent cross-infection. Everyone who goes into hospital has a huge fear of cross-infection and of being infected with MRSA. People are afraid to go into hospital as a result. I can only imagine what cystic fibrosis patients face given that they are prone to infection.

The funding allocated for cystic fibrosis is not being spent in that area. In 2006, some 57 additional staff were to be appointed in this area. One fifth of the budget for 2006 has not been allocated and the situation will be worse in 2007-08 with the ban on recruitment in the health service. It is not only impacting on cystic fibrosis patients, but it is also impacting on nurses, physiotherapists, occupational therapists, home help, speech therapists and psychologists. It is impacting on the most vulnerable in our community. Elderly people who need one or two hours of home help per week cannot get it because the resources are not being provided.

Last week, there was the announcement about the redefinition of services in the north east. The same thing is happening in the west. This month, the Minister for Health and Children and the HSE will make an announcement regarding the review of services at the county hospital in Roscommon. It will probably see the transfer of surgery, accident and emergency services and intensive care services from Roscommon to Portiuncula Hospital in Ballinasloe, where ward closures have already taken place. In December 2007, there were 102 people on trolleys in the state-of-the-art accident and emergency facility in Roscommon. We are now going to transfer those to the prefabs in Portiuncula Hospital in Ballinasloe that cannot even cater for the existing demand there.

Deirdre Clune (Cork South Central, Fine Gael)
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We are here debating this issue, but when the Dáil was not sitting in January, the media highlighted the lack of services for people suffering from cystic fibrosis. Orla Tinsley's wonderful article in The Irish Times probably sparked the whole debate. It is appalling that the Government and the HSE only react when the media raises an issue. The saddest thing about all those stories is that they involve young people suffering from cystic fibrosis who know that if they were living in another jurisdiction their quality of life and life expectancy would improve. These young people just do not know what the next infection will bring for them.

The media highlighted the case of 12 year old Ann-Marie Kelleher last week, who is suffering from Rett syndrome and scoliosis. There was a reaction from a private donor, who volunteered to pay for her operation in the UK, but all of a sudden the HSE found the funding and provided the services she needs under the National Treatment Purchase Fund. It is a sad day for the Government when it only reacts to what is highlighted by the media. That is no way to run a health service.

There has been an asset stripping of our mental health services and a lack of funding that should have been in place for 2006 and 2007. We now have no funding for 2008. The National Suicide Prevention Office does not have sufficient funding this year. We have no psychiatric bed facilities for young people. There have been stories of young people in adult wards. The situation is appalling and we badly need investment. The amendment the Government is asking us to support is an insult. The last paragraph asks us to acknowledge co-location and the fact it is providing beds in the system. What are private hospitals on public grounds going to do for those who are suffering from cystic fibrosis and those who are suffering mental health problems? It will do absolutely nothing for them and it is an insult to throw that paragraph into the Government's amendment.

I support the motion tabled by Deputy Reilly. We need investment in mental health services, especially community services. I listened to a woman last week telling me that she was discharged from psychiatric services but that there was no community service and no come back. Nobody was supporting her or ringing her to find out how she was getting on. Nobody even knew where she was going when she left the hospital. That is a revolving door system and the woman will be back again from the lack of support and services in our community. We need urgent action in this area and we certainly do not need the neglect that has been evident from this Government.

Tom Hayes (Tipperary South, Fine Gael)
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I support the sentiments that have been expressed. I recently went to a briefing of the south Tipperary branch of the Cystic Fibrosis Association of Ireland. I looked for the briefing in order to inform myself better on something about which many people had come to me as a result of the radio programme where the issue was highlighted. I cannot remember the last time that I saw such anger, tears, disappointment and utter disillusionment with the work of the Government. These emotions were universal throughout the room. I met families who felt utterly isolated by the Government. They felt the Government had turned its back on their plight. We have lived through the most extraordinary growth this country has ever known, yet patients have seen no improvement and have only experienced further distress. Things have not improved this year for patients, in fact they have got worse.

I heard heart rending stories about people and their struggle with a life-altering illness requiring huge sacrifice from every family member. These are sacrifices in time, money, comfort, careers and other aspects. It is time consuming for all concerned. There are hours of physiotherapy every day, along with over 50 tablets daily, fitness tests, hospital visits, consultant visits, emergency room waits and so on. The HSE does not come out of this very well. We have heard enough negativity so I will not go on about it. We should do more from now on.

The essential requirement of bypassing the accident and emergency department and providing isolation units for cystic fibrosis patients is absolutely key to this. I believe some improvements will be planned in this area. Getting a medical card and a carer's allowance should not be means tested for those patients. The families affected should not struggle to finance constant medication, doctors' visits, standard physiotherapy appointments and varied sports activities so that children can get adequate exercise and diet. They should not struggle to finance high calorie diets with expensive diet products, transport to hospitals and overnight stays. The reality is that these people suffer a great amount and we should not allow that to continue.

Olwyn Enright (Laois-Offaly, Fine Gael)
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The Minister is aware that the HSE is receiving €370 million less than it believed necessary to maintain the existing level of services for this year. The HSE clearly has been preparing for this, judging by its actions at local level. I raise this issue because I have been unable to get a satisfactory response from the HSE to questions I asked over the last few days, where I was effectively refused proper information on what it is doing and who will be affected. There is a widespread rumour circulating that up to 140 staff contracts will not be renewed at the Midland Regional Hospital in Tullamore, as well as a smaller number in Portlaoise. I cannot verify the figure because nobody from the HSE will tell me. When I quote a figure they tell me they did not say that. Their response is that contracts are frequently not renewed and that contracts are often for a specific job only. This belies the fact that those whose contracts are being examined include nurses, attendants and porters, all of whom are involved in the delivery of front-line services. The notion that a nurse's work is complete is nonsense and the HSE's actions will have a direct effect on patients.

There are four orthopaedic surgeons in Tullamore who are each only doing one hip operation per week, because 12 surgical beds and four general beds have been closed to balance the books. In the absence of the Minister for Health and Children, I ask the Minister of State to direct the HSE to state publicly what contracts are under threat and what effect this will have on services delivered to patients. What effects will this have on the opening of all facilities in Tullamore?

I join with Deputy Reilly and my colleagues in their comments on those suffering from cystic fibrosis. The unimplemented Pollock report was published three years ago this month. I asked the Minister about her policy on the care of cystic fibrosis patients, about adequate segregation and about comparisons in mortality rates as far back as 2005. I was told that the HSE multidisciplinary working group's work was at an advanced stage. This remains the standard response, but the many patients who spoke, often on behalf of those who could no longer speak for themselves, proved all that is at an advanced stage is their own disease.

Why is the mortality rate so poor here when compared to so many other countries? What steps will be taken to address this? We are now told, in incremental stages and depending on the level of negative publicity, that six single rooms will be provided in Saint Vincent's University Hospital in the next ten to 18 weeks. Can the Minister of State provide us with an exact timescale for the delivery of isolation facilities, both for inpatients and outpatients, on a sufficient level and geographical spread, to address the needs of patients across the country? The urgency of this cannot be overestimated. It is utterly cruel to leave these young men and women exposed to MRSA and other life-threatening diseases. I am not sure whether the Government fully grasps the trauma for a young person in a ward with a much older seriously ill patient suffering from a range of illnesses and reacting in different ways. Adding in the fact that the illnesses of such elderly patients can affect their lives we can get some idea of what a cystic fibrosis patient may have to face. All Members of the House want to see real and immediate improvements for cystic fibrosis patients. The difference, however, is the Government has the power to deliver, and patients are definitely not seeing improvements.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I move amendment No. 1:

To delete all the words after "Dáil Éireann" and to substitute the following:

welcomes the significant revenue investment of €6.78 million since 2006 for the development of cystic fibrosis services nationally, the resultant improvement in services and the plans for further significant capital investment during 2008 and beyond to improve hospital facilities, including isolation facilities, for these patients;

welcomes the unprecedented level of funding being invested in mental health and commends the Government for the allocation of €51.2 million since 2006, which represents a third of the additional resources required to implement A Vision for Change over the stated 7-10 year period;

notes the assurances by the Health Service Executive that no decisions have been taken to reduce frontline services in the North East and that in progressing the reconfiguration of services in the region, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place;

acknowledges the improvements in frontline accident and emergency services over the last three years and in particular the overall reduction in the number of patients who were awaiting admission to hospital from an emergency department over this period;

welcomes the cumulative increase in funding for health services of €4.3 billion provided by the Government to the HSE over the four years 2005 to 2008 and notes the substantial improvements in services which have been provided as a result; and

welcomes the progress made since 2001 in providing on average over 1,600 additional public acute beds and endorses the commitment of the Government under the Agreed Programme for Government to provide a further 1,500 additional public acute hospital beds under the co-location initiative, and through the national development plan."

I welcome the opportunity to respond on behalf of the Government and my colleague, Deputy Mary Harney, the Minister for Health and Children, to this motion. Deputy Shatter should know that the Minister for Health and Children is on a long-standing trip to Arizona, arranged by her Department, to visit cancer facilities there.

James Reilly (Dublin North, Fine Gael)
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It could not have been adjourned for six weeks later.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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It was arranged some months ago by the Department of Health and Children. The implication made by Deputy Shatter was quite disgusting.

James Reilly (Dublin North, Fine Gael)
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She did not go to the Superbowl.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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This is an opportunity to debate our health services, the policies we are implementing, and the progress our country is making on the basis of facts.

If our debates are not informed by facts and a recognition of progress that has been and is being made, then we have no rational basis on which to map out what needs to be done next, to make clear what our priorities should be, how to allocate funding, and how to build sustained improvements and higher performance. This is the only basis on which those of us involved in doing, rather than commentating, can act. It is only by recognising real progress that we can address real issues.

I do not want to rehearse a long list of general statistics, but I want to address particular aspects of the debate this evening. It is the truth, for example, that life expectancy has increased rapidly in Ireland in the last two decades, one of the fastest rates in the developed world, and especially since 1999. Our cardiac and cancer services are improving constantly and are far improved from where they were, only ten years ago. Waiting times for common operations have been cut from years to months. The number of people with medical cards has been rising again since 2004 and more people can visit the doctor free of charge than at any time since the early 1990s. Our hospital services are expanding in range, depth and volume with many hundreds more consultants and specialist staff treating tens of thousands more people. We now have home care for 10,000 older people where we had none a few years ago. We have breast cancer screening where we had none and we will soon start cervical and colorectal screening.

These are facts. It is real progress and we are determined to build on this reality. We are not where we want to be yet, but we are getting there.

I will turn to some specific aspects of the debate and first I will address the cystic fibrosis services. The improvement of services to persons with cystic fibrosis has been a priority for the Government and for my colleague, the Minister, Deputy Mary Harney. We are as concerned as anyone in this House to improve services and facilities for people with cystic fibrosis. We understand the frustration of patients and their families while new facilities are yet to open. However, we have begun to make progress in services.

Following publication of the Pollock report in 2005, the Health Service Executive established a working group to undertake a detailed review of cystic fibrosis services. The group, which was multi-disciplinary in its composition and included representation from the Department of Health and Children, was asked to review the current configuration and delivery of services to persons with cystic fibrosis in Ireland. It identified a range of service improvements required, including the need to increase the level of clinical, nursing and allied health professional staffing in cystic fibrosis units around the country.

Arising from the Pollock report and the emerging recommendations of the working group, the Minister for Health and Children allocated additional revenue funding of €6.78 million to the HSE in 2006 and 2007. This helped in the appointment of 44 additional staff, covering both adult and paediatric services across a number of hospitals, throughout the country. The necessary funding is available to facilitate the recruitment of a further 37 staff nationally.

The HSE was asked to place a particular focus on the development of services at the national adult tertiary referral centre at St. Vincent's Hospital, here in Dublin. A number of capital projects have recently been completed at the hospital and have helped to improve facilities. These include a new ambulatory care centre, the refurbishment of St. Camillus's ward, and a new accident and emergency department which includes single room accommodation. I accept that these developments do not address the immediate needs of patients. For that reason, the HSE is currently fast-tracking the re-development of a ward which is adjacent to the main cystic fibrosis treatment area. The project is to commence within the next few weeks and will provide six single rooms. On completion, additional work will begin to provide a further eight single rooms. This will result in a total of 14 single rooms for cystic fibrosis patients by the end of the summer.

In the longer term, a new ward block is to be built and will include 120 replacement beds in single en suite accommodation, including accommodation for cystic fibrosis patients. Planning permission has been obtained, financial provision has been included in the HSE capital plan and the contract is to be awarded this year. It will be a condition of the contract that the design and build period is to be not more than 24 months from the date of contract award.

Beaumont Hospital operates as a regional centre in providing services to adults with cystic fibrosis. In the 2008 budget a special allocation of €2.5 million capital funding was provided to enable Beaumont Hospital to provide outpatient facilities for cystic fibrosis patients.

An independent registry for cystic fibrosis has been established. As yet, the data is not available to fully inform analysis relating to median survival in this country. When it is available, the data from the registry will allow for benchmarking against comparable countries around the world to measure the performance of our healthcare system.

Alan Shatter (Dublin South, Fine Gael)
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What about neo-natal testing? Will the Minister of State tell the House when that will start?

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I will now turn now to the area of my responsibility, mental health services.

Alan Shatter (Dublin South, Fine Gael)
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He does not know.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The report of the expert group on mental health policy, A Vision for Change, which was published in January 2006, sets out a comprehensive policy framework for our mental health services over a seven to ten year period. The report proposes an holistic view of mental illness and recommends an integrated, multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. Special emphasis is given to the need to involve service users and their families and carers at every level of service provision. Some misconceptions appear to have arisen on the funding requirement for the implementation of A Vision for Change and I welcome the opportunity here this evening to correct them.

The estimated additional cost of implementation is €150 million, that is, €21.6 million per year over seven years, or €15 million per year over ten years.

Dan Neville (Limerick West, Fine Gael)
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Some €25 million was promised for every year, which was not spent and it is now €27 milllion, as revealed by a freedom of information request.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The report is clear that new funding should follow implementation, and in this regard a total of €51.2 million has been allocated since 2006.

Dan Neville (Limerick West, Fine Gael)
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It was not spent, yet it was in a HSE document.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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Thus, in the first two years of a seven to ten year implementation period, one third of the overall requirement has already been allocated.

Jan O'Sullivan (Limerick East, Labour)
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It was not spent.

Dan Neville (Limerick West, Fine Gael)
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The Minister of State should deal with the fact that €51 million was not spent on A Vision for Change and that only €27 million was spent.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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In view of this very significant additional investment in 2006 and 2007, it is appropriate, and indeed prudent, in 2008 to ensure consolidation of the investment to date and to make sure that the funding delivers what is intended. In addition to the extra funding required to fund service developments, the report notes that existing resources within the mental health service should be remodelled and reallocated.

Dan Neville (Limerick West, Fine Gael)
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That is 7% of the total health budget.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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There are of course substantial resources already invested in mental health. In 2007, an estimated €1 billion was spent on these services.

Dan Neville (Limerick West, Fine Gael)
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A total of €1 billion out of a total health service budget of €14 billion. One in four people will have a psychiatric condition in the course of his or her life.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The implementation of A Vision for Change is therefore dependent to a much greater extent on the remodelling of existing resources, rather than on new funding. It is also clear that both the additional investment and the reorganisation of existing mental health services and resources must be managed in parallel.

Dan Neville (Limerick West, Fine Gael)
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The Minister of State is worse than the former Minister of State, Mr. Tim O'Malley.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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Deputies will no doubt accept that it is necessary, in the context of the ever-increasing demands for health resources, that mental health expenditure be closely monitored to ensure that services demonstrate effectiveness and efficiency.

Dan Neville (Limerick West, Fine Gael)
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In other words it should be reduced.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy will have his turn later.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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Before any further additional funding is provided, it is essential that the HSE is in a position to demonstrate that the funds allocated for mental health services are efficiently used——

Dan Neville (Limerick West, Fine Gael)
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In other words the €51 million allocated by the HSE——

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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——and that the substantial changes in the organisation and delivery of mental health services envisaged in A Vision for Change are progressed in a timely fashion.

Dan Neville (Limerick West, Fine Gael)
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That is what the Minister is funding.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The HSE has advised the Department of Health and Children that because of competing expenditure pressures and the overriding obligation to live within the approved overall allocation, some of the planned developments in mental health services in 2006 and 2007 have been delayed. While this has been disappointing to me and to all involved in mental health services, I note that some of these developments will proceed in 2008, for example, the provision of eight additional consultant child psychiatry teams, the provision of 18 additional beds for children and adolescents at St. Anne's, Galway, St. Vincent's, Fairview and St. Stephen's Hospital, Cork. The provision of these beds will increase the bed complement from the current provision of 12 to 30 during 2008.

Dan Neville (Limerick West, Fine Gael)
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Thirty beds. Does the Minister of State think that is adequate?

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The construction of two 20-bed units for children and adolescents in Cork and Galway——

Dan Neville (Limerick West, Fine Gael)
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Thirty beds for children.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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——is expected to commence this year and be completed in 2009. It is a pity Deputy Neville does not listen.

Dan Neville (Limerick West, Fine Gael)
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I am listening, that is why I am responding.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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In the context of the 2008 service plan, the Minister, Deputy Harney, pointed out to the HSE that there can be no question of diverting service development funds to meet expenditure pressures arising in relation to core services. She expressed her concerns about the development of mental health services in line with A Vision for Change. The Minister also pointed out that she believes there is scope within the HSE's overall allocation to deliver further service enhancements in 2008, over and above those outlined in the service plan, through improved performance, productivity and realignment of existing resources.

Dan Neville (Limerick West, Fine Gael)
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What is being allocated this year in A Vision for Change? Nothing.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The HSE has primary responsibility for implementing the recommendations in A Vision for Change. I understand that the HSE implementation plan has been finalised and it is expected to be presented to the board next week.

Dan Neville (Limerick West, Fine Gael)
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What is the Minister of State allocating this year?

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I will meet the HSE and the implementation officer shortly to pursue these issues. I am pleased to reassure Deputies that the Government is committed to the provision of a high quality mental health service. The service is underpinned by the comprehensive policy framework outlined in A Vision for Change and in Reach Out, the national strategy for action on suicide prevention.

Dan Neville (Limerick West, Fine Gael)
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What is the allocation for this year?

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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Furthermore, it is supported by the legislative reforms contained in the Mental Health Act 2001 and has been in receipt of unprecedented levels of funding in recent years. Reach Out aims to prevent suicidal behaviour, including deliberate self-harm, and to increase awareness of the importance of good mental health among the general population. A key component of Reach Out is to develop and implement national training programmes. The HSE's National Office for Suicide Prevention, which oversees the implementation of the strategy, is engaged in a significant level of training including the ASIST, Applied Suicide Intervention Skills Training, programme and has already trained 91 trainers——

Dan Neville (Limerick West, Fine Gael)
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Which is appalling because they were held in hotels.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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——and delivered over 200 two-day workshops to more than 5,000 people across the country. In October 2007, I had the pleasure to launch the National Office for Suicide Prevention's mental health awareness campaign.

Dan Neville (Limerick West, Fine Gael)
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I went to the Burlington because it would not pay for the hotel.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The main aim of the campaign is to influence public attitudes to mental health. I cannot be held responsible for the Deputy's meanderings around Dublin.

Dan Neville (Limerick West, Fine Gael)
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The Minister of State is not responsible for too much.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The campaign is specifically designed to change negative attitudes and to promote positive attitudes to mental health. The campaign was developed by the National Office for Suicide Prevention in partnership with key voluntary and statutory agencies working in the area of mental health in Ireland.

I assure the House of my personal commitment to the provision of quality care in the area of mental health, to upholding the civil and human rights of those who suffer from mental illness and to encouraging measures aimed at combating the stigma that is so often associated with such illness. I welcome the establishment of the Office for Disability and Mental Health, announced by the Taoiseach on Wednesday, 30 January 2008. The office will support me in the exercise of my functions in relation to disability and mental health across four Departments. In regard to mental health, the office will focus in particular on driving the implementation of A Vision for Change and will, I am confident, lead to more coherent policy making and the more effective use of resources. The establishment of this office makes the political commitment to mental health by the Government a reality.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I understand the Minister of State, Deputy Devins, wishes to share time with Minister of State, Deputy Hoctor.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I beg your pardon, I should have stated that earlier.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am pleased to have the opportunity to address the House in this debate. In particular I want to build on what the Minister of State, Deputy Devins, has just said in terms of the Government's total commitment to improving the health services and working from the progress we are already making.

Since 2004, the Government, particularly the Minister, Deputy Harney, have organised the largest ever expansion in services for older people, covering every area from new home care supports, more home help, long term care, palliative care and measures to counter elder abuse. This is about more services and more innovative services, closer to older people's homes, designed around their needs and resulting in much better support than ever before. Our plans and our commitment as a Government is to do more, year in, year out, to make steady, constant progress in supporting older people in every way possible.

I wish to focus some remarks on the financial aspects of the debate, because it shows just how much we are backing up the reform process with high levels of investment. This year, there is an increase of €1.1 billion in overall health funding. This is being done when most economic experts are predicting a difficult period internationally which will affect our economy too.

In 2008 the Government is providing a total of over €16 billion for expenditure on the health group of Votes. This is made up of the €14.931 billion for the HSE, €695 million for the Office of the Minister for Children and €530 million for the Department of Health and Children. This represents an increase in health funding of 9%. Once again, it places Ireland very high in international terms in relation to growth in public health spending. This funding will enable, for example, the continued prioritisation of services for older people and people with disabilities, and the cancer control strategy.

To put matters into sharp focus I draw attention to the following facts. The revenue funding to the former health boards in 2004 was €9.8 billion. The funding being provided to the HSE for service delivery this year in 2008 is €14.3 billion, an increase of €4.5 billion or over 10% a year for the four years since the HSE's establishment. In international terms according to the OECD, health spending in Ireland grew in real terms by an average of 9.1% per year between 1999 and 2004 while the OECD average was 5.2%. Total health spending accounted for 7.1% of GDP and about 8.5% of GNP. The relevant GNP measure is very close to the OECD average of 8.9% and this is without any adjustment for our generally younger age profile.

In terms of health spending per capita, Ireland spent US$2,596, adjusted for purchasing power parity, in 2004. This is over the OECD average of US$2,550. Alongside Norway, in 2004, Ireland had the highest level of public capital investment in health as a proportion of national income. At 0.6% of GNP, this is twice or more times the level of most OECD countries. The national development plan will continue a very high level of public investment generally and health capital development in particular. To illustrate the Government's commitment to high levels of public health spending, in Ireland nearly 80% of health spending is funded by government revenues, above the OECD average of 73%. This compares to a figure for Ireland of 71.5% in the mid-1990s. This is the record of Government since 1997, consistent under three Ministers for Health and Children.

Improving the delivery of accident and emergency services continues to be a top priority for the Government and the Health Service Executive. Considerable improvements have been made during the past two years in the delivery of services in emergency departments. The number of patients awaiting admission to a hospital bed from accident and emergency departments reduced by 50% between December 2005 and December 2007, from an average of 155 to 78 per day. While there was an increase in the numbers in recent weeks due, for example, to increased levels of the winter vomiting bug and increased levels of influenza and chronic obstructive pulmonary disease, the HSE is working intensively with the hospital system to bring about further sustainable improvements. The HSE and hospitals have our full support in urgently improving known processes that will speed up care and reduce waiting times for patients. This is as vital as the new investment we have already made in hospital and long-term care capacity.

One of the key issues being addressed is the system of discharge planning. A major focus is being placed on ensuring the following: that all patients have an expected date of discharge within 24 hours of admission, that the expected date of discharge is actively managed on a daily basis against the treatment plan and any changes are communicated to the patient, that patients can be discharged in a more proactive manner at weekends, that there is an increased emphasis on nurse facilitated discharges and that ward rounds are scheduled in a way that facilitates a more timely review of treatment plans. The HSE is also working closely with a number of hospitals which are reporting significant numbers of patients awaiting admission. This includes a specific focus on the establishment of clinical decision units and short stay units to accelerate the throughput of patients who present at emergency departments. Additional measures are also being put in place to deal with the issue of delayed discharges.

I also hope in light of the successful conclusion of talks on the new contracts for consultants that progress will be made in advancing the recruitment of additional consultants under the "100 plus" initiative previously announced by the HSE. The initiative is designed to reward hospitals which are operating in line with established performance targets. The additional consultants are to be employed in specialties which can alleviate the problems which manifest in emergency departments.

The HSE is also arranging for 200 additional beds to be contracted in private nursing homes with a particular focus on major Dublin hospitals. The HSE advises that 98 of these places have been filled since the middle of January, with 85 filled in Dublin. In addition, the HSE advises that it will be opening an additional 100 long stay beds from March onwards in a new community nursing unit at St. Mary's Hospital in the Phoenix Park. These will be used mainly for older people who have completed their acute phase of treatment. These developments follow on from the opening in December of 94 additional long stay beds at Cherry Orchard Hospital.

The HSE is proceeding with the implementation of an additional 360 home care packages in 2008 at a cost of €10 million. It is intended to prioritise these additional home care packages to support in particular the Dublin area and also a number of the other large urban areas and specific acute hospitals in Cork city, Waterford, Wexford, Limerick, Galway and Mayo. Some 120 of these are scheduled for implementation in the first quarter. We can be confident that the combination of these measures will lead to continued improvement in emergency departments.

With regard to acute hospital beds, the health strategy of 2001, Quality and Fairness — A Health System for You, identified a requirement for additional capacity throughout the health system and a need to reconfigure services to achieve maximum efficiency and effectiveness. This covers acute services, primary care and continuing or long-term care, all of which is being progressed.

For acute hospitals the strategy estimated that 3,000 beds were needed in the acute hospital system by 2011. It is well recognised that acute hospital care is just one component of the health care delivery system. Hospital services cannot be evaluated in isolation from primary care, community and specialist services. The need for hospital services is influenced by the availability and accessibility of those other services. In 2001, the average number of inpatient beds and day places available for use in the 53 acute hospitals, now under the National Hospitals Office, was 12,145. The provisional number of acute hospital beds recorded by the HSE for 2006 was 13,771 — some 12,574 inpatient beds and 1,197 day places — based on a total bed complement.

Significant progress has been made in providing the additional 3,000 beds. On average, over 1,600 inpatient beds and day places have come on stream since 2002. Far from falling behind, this represents one the fastest rates of expansion of acute hospital capacity in our country's history. In the modern era there has never been such a rate of new acute beds coming on stream. The Government is committed in its programme to providing an additional 1,500 beds. Approximately 1,000 of these will be provided through the co-location initiative and the balance through the Health Service Executive capital plan. Both of these tracks are progressing well.

With regard to the provision of 1,000 beds under the co-location initiative, this will be achieved by freeing up existing public beds through the development of private hospitals on the sites of public hospitals and the transfer across of private activity. Significant progress has been made so far. Project agreements for the six hospitals where successful bidders have been approved are due to be signed in the very near future. Two further hospitals which are participating in the co-location initiative are at an earlier stage of the procurement process. The co-located private hospitals will most likely open within three years of receiving planning permission. This means that available public bed capacity in public hospitals will be expanded simultaneously. Overall, it will mean new public beds being made available fast.

With these developments, the Minister asked the Department and the Health Service Executive to review public capacity requirements in the acute hospital sector up to 2020 in the light of developments since the health strategy and the progress of this initiative. The Health Service Executive recently published a review of acute bed capacity which proposes an integrated approach to health service delivery that seeks to achieve the right balance between inpatient, day case and community based care. The review found that with future challenges, such as our ageing population and the increase in chronic diseases, we will need to plan for a 60% increase in demand for health care by 2020. It suggests that if current practices and processes continue, the demand for public hospital beds will escalate to nearly 20,000 by 2020. To meet this need we would have to provide the equivalent of 12 new 600-bed hospitals over the next 13 years. It concludes that such reliance on acute hospitals for service delivery is neither sustainable nor in the best interests of patients.

The review examined alternative approaches to meeting this demand. It recommends an integrated approach to health service delivery involving substantial change in the way care is provided. Among the measures proposed are significant increases in day beds in hospitals, more long-term care beds, more rehabilitation beds and more services in community-based, non-acute hospital settings. The report acknowledges that additional beds are planned under the co-location initiative and under the HSE capital plan, and that this will meet the current needs. The review also advises that services in acute hospitals should not be altered until viable and appropriate community-based alternatives are in place. We believe the review forms a basis for discussion with key stakeholders on how best to plan for the provision of public health care delivery to 2020.

The Government is also committed to the continued development of primary care services and community services for older people. We will be developing and enhancing the range of services available in the community and providing for additional beds in the community for older people.

What I have outlined gives a clear demonstration of the significant progress that has been made by the Government in its commitment to delivering an additional 3,000 acute hospital beds over a ten-year period, a target which, I am confident, will be met.

Jan O'Sullivan (Limerick East, Labour)
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I wish to share time tonight with Deputy Ó Caoláin and tomorrow with Deputies Upton and Lynch.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

Jan O'Sullivan (Limerick East, Labour)
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The Minister of State moved the Government amendment, which states that Dáil Éireann "welcomes the unprecedented level of funding being invested in mental health and commends the Government for the allocation of €51.2 million since 2006, which represents a third of the additional resources required to implement A Vision for Change over the stated 7-10 year period". This misleads the House because the implication is that the €51.2 million is being spent on implementing A Vision for Change. Last Thursday, during Oral Questions to the Minister for Health and Children, a number of Deputies about A Vision for Change. Part of the Minister's reply was as follows:

The Department of Health and Children has been advised by the Health Service Executive that the additional €51.2 million development funding was not used as planned because of competing expenditure pressures and the overriding obligation on the Health Service Executive to live within its approved overall allocation. As a result, some of the planned developments in mental health services have been delayed.

There is a very nice phrase in the paragraph which states: "It is appropriate in 2008 to pause and review the situation to ensure consolidation of the investment to date". In my opinion, that is traitorous to people with mental health needs. A clear commitment was given in the document A Vision for Change and funding was allocated but it has clearly not been spent. I share Deputy Neville's frustration and I do not blame him for leaving this debate tonight because he has fought on this issue over a long number of years. The fact is, however, that the money allocated for mental health was diverted to balance the HSE's books. That was clearly stated last Thursday in a reply to a number of Deputies from the Minister for Health and Children, so let us not cod ourselves that this €51.2 million, referred to in the Government amendment, has been given to mental health because it has not. It is shameful considering the patients we are dealing with in this health service sector. These people have been let down over the years. They finally got a document that was supposed to address their needs, including a commitment that money would be spent, but it was diverted to other services in order to balance the books. That is absolutely disgraceful. On top of that, capital moneys from the sale of old psychiatric hospitals was meant to be ring-fenced. The former Minister of State, Deputy Tim O'Malley, clearly stated on the record that that money would be spent on mental health services but we are now told it will be spent on health services. Therefore people in the mental health sector have been let down again.

I wish to reiterate the proposal from the Labour Party and Fine Gael in advance of the general election, which was that we would ring-fence 10% of health spending on mental health. The only way the needs of that sector will be properly addressed is to ring-fence money in the health budget. The HSE is leaking money right, left and centre but is not spending money on areas for which it has been allocated. It is the Minister's duty to ensure that money is spent according to budgetary allocations. If the Minister, Deputy Harney, was present I would clearly call on her to do that. I did not get an opportunity to read these replies during oral questions last week as they came in later. The situation is shameful, particularly as children are in adult psychiatric wards because we do not have enough beds for them. There are 12 child and adolescent psychiatric beds in the whole country. We have been told the number will rise to 30, although the figure in A Vision for Change is 80. We are going to have such beds in Dublin, Galway and Cork but in the entire mid-west region, including my own constituency, not one single child and adolescent psychiatric bed has been, or will be, provided. Many moons ago when I was on a health board — and we keep hearing health boards being castigated — funding for such beds was to be delivered in the service plan. That funding was meant to be supplied for beds in Limerick as well as in other areas. We now have waiting lists for years for young children to be assessed for speech and language therapy by community care teams. That is disgraceful because it holds children back when we could so easily address their problems when they are young and give them some kind of quality of life. The mental health services are being treated dreadfully so I hope the Minister of State, Deputy Devins, will fight his corner for funding because there is a big fight to be fought.

I commend Fine Gael on tabling this motion and in the time remaining I wish to address some other aspects of it. I agree with Deputy Clune that it is wrong that people should have to campaign in the media for health services. Young people with cystic fibrosis went on the Joe Duffy show coughing and in obvious distress. We hope they will now get the required temporary unit of 14 beds before the end of the summer, along with a commitment to a more permanent unit in St. Vincent's by the end of 2010. I agree with previous speakers that the timeframe is extremely long but it would not have happened if those young people had not gone on the airwaves. We do our best in here but sometimes I think we are wasting our breath because the battle is all being fought out on the airwaves, which is how people can get their health services. It is crazy that people must try to climb over others to get attention in the media for their basic health needs.

I want to highlight the case of Ann-Marie Kelleher in Cork and will read out some of what I read about her in the The Irish Times of Saturday, 2 February 2008. She has curvature of the spine which, by the time she got to see a specialist in England, was over 100%. On 6 September 2007, her mother and father wrote a letter to Crumlin Hospital where she is on a waiting list for surgery, which stated:

She cannot sit up any longer, she cannot sleep as she is literally wriggling around her bed hoping she will get a comfortable position that will allow her to sleep. She would need changing three to four times throughout a single night due to the sheer exhaustion of trying her best wriggling about her bed trying to get comfortable for sleep. She is in a ball of sweat constantly dealing with the sheer discomfort. It is nothing short of cruel watching over her. It is heart-breaking when surgery can change her life.

That letter went to the hospital and subsequently she was supposed to have an appointment either on 28 November or 2 December. It turned out that was never actually pencilled in, even though it was notified to the HSE. Then she was to have had another appointment which had to be cancelled because an anaesthetist was not available. In the meantime, she had gone to the media and had visited a doctor in London who said the curvature was over 100%. He said he was confident the surgery, which would have to be done at two different sittings about a week apart, could be arranged fairly swiftly.

The waiting list for children in need of spinal surgery in Crumlin is, according to the hospital, up to 12 months long. The hospital has said that 46 children are awaiting such surgery there. They cannot go to Temple Street Hospital because there is an excessively long waiting list there also. This child is one of many waiting for spinal surgery but when she went to the media the problem was suddenly gone and she could have her treatment abroad.

The HSE says it is getting €370 million less than it needs to maintain services next year, so we will have a continual build up of waiting lists. Three months before the end of last year, the HSE had to bring in an embargo even thought it received a much increased allocation in 2007. I do not know what will happen to the health services over the next year. We were told that many developments were delayed because of the consultants' contract negotiations and we are now told that because that situation has been sorted we will suddenly get new services. The fact is, however, that people in the HSE balance their budgets by using money that was supposed to be for new services. They could not bring in those new services because they were told they could not employ new contracts because of the consultants' contract situation. If we are to bring in the new consultants and the fair deal, which was another big chunk of money they did not have to spend last but will spend this year — along with the payback to people who were wrongly charged in nursing homes — how will the HSE balance its books this year? How will people on waiting lists get treatment?

On 31 December 2007, a newspaper article stated that in some cases people were waiting over four years for outpatient appointments in parts of the country. I fear for the health services in future because I do not think the HSE has the capacity to deal with these issues. People like young Ann-Marie Kelleher are waiting in distressing pain, yet we will have more and more such stories on the Joe Duffy show because people see that is how they can obtain their health service requirements. Somebody will have to call a halt to this.

Last Saturday week, I held a meeting in the Mansion House on universal health insurance. We must have a system whereby money goes towards treatment. At the moment, if one is running a big public hospital it does not make sense to have many acutely ill people because they cost a lot of money. One must balance the budget one gets irrespective of how many patients are treated. Patients cannot be discharged because there are not enough step-down beds, so it makes sense to have people occupying beds who do not need a large amount of acute treatment. The whole system is designed to use money badly and not to provide services where they are needed. I am afraid that more and more people will approach the media in order to get basic health services. I fear people with mental health problems and others who cannot shout very loudly will be put to the back of the queue. Money must be ring-fenced, in particular, for mental health services. Unfortunately, we will have many debates on health issues this year. I hope solutions will be proposed but given that the HSE has been in existence for three years, we need to go back to the drawing board regarding the delivery of health services.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank Deputy O'Sullivan for sharing her time.

There is something deeply sick and shameful about a society where wealth and luxury are valued to such an extent that exclusive hotels, golf clubs and health resorts can be developed and built in a short time and supported by tax breaks for their wealthy owners, while very ill people have to wait for years in dangerous and disgraceful conditions before they see even the prospect of better facilities. Such is the case with cystic fibrosis sufferers in this State. The Pollock report was completed in 2004 and published in 2005. It has not been implemented and people with cystic fibrosis face waiting lists, overcrowding and dangerous exposure to infection, all due to the scandalous neglect of successive Governments.

I welcome and support the motion in the name of the Fine Gael Deputies and the priority given to cystic fibrosis among the health issues addressed in it. The response of the Minister for Health and Children to my parliamentary questions and those of other Deputies is not good enough. Every effort must be made to provide all the facilities required for people with cystic fibrosis, as recommended by the Pollock report. No excuses will be accepted. Once again we are debating a Private Members' motion highlighting the perilous state of our health services due to the fundamentally flawed policies and mismanagement of the Government and the HSE. A look back at the past month alone shows the depth of the ongoing crisis.

People in the north east region, comprising Counties Cavan, Monaghan, Louth and Meath, are incensed by the programme of cuts across all hospital services and at every hospital site in the region revealed in the leaked HSE memo. Yesterday it was confirmed in the Irish Medical News that the plans for the north-east region were discussed at the December meeting of the HSE board and that these plans will be the blueprint for cuts in every region throughout the State. This is something we in the north east, particularly those campaigning to save Monaghan General Hospital, have repeatedly pointed out. The knives that will be used to cut services in other regions have been tested and sharpened on the people of our region, particularly the people of County Monaghan.

What will the Fianna Fáil Deputies from Counties Cavan, Monaghan, Louth and Meath do about it because they are the people with the greatest opportunity of making a considered impact on Government, Department and HSE thinking? There is no use in them shaking their heads or tut-tutting to constituents and blaming the Minister, Deputy Harney, or their own party leadership for the 1980s style cutbacks that the HSE is preparing to impose in our hospitals. This week in the Dáil they have the opportunity to make their voices heard by supporting this motion or, at least, refusing to support the Government amendment. They must make a stand. It is not good enough that Opposition voices are continuously crying out for this to stop while others are clapped on the back and nothing more.

I challenge these Fianna Fáil Deputies individually and collectively to make their voices heard. Instead of voting tomorrow night they should meet and devise a common approach to help ensure these cuts do not proceed. They must take some initiative. Lobbying the Minister or coming back with a reply to this, that or the other does not make the critical difference.

The proposed slashing of services includes the closure of ten beds at Monaghan General Hospital, the reduction of outpatient clinics to four days per week in Cavan and Monaghan General Hospitals, the reduction of elective surgery to a four-day week in Cavan and Monaghan and the taking of Monaghan "off call" completely, rendering its medical and treatment room redundant. I respectfully challenge Cavan-Monaghan Fianna Fáil Deputies Rory O'Hanlon, Brendan Smith, Minister of State, and the newly elected Deputy Margaret Conlon. Will they support the Government amendment and simply troop in behind the Taoiseach and the Minister for Health and Children while pretending to the people of Counties Cavan and Monaghan that they are doing something to stop these cuts? I say to them, please do not take the people of Cavan and Monaghan as fools. I have no doubt that each and every one of us will be judged not by what we say but by our actions. Those Members have an opportunity and they must grasp the nettle and show leadership on these issues. Let there be no mistake about it, If they did that, the Opposition voices representative of that constituency would row in fully behind them.

Cuts are also planned in orthopaedic surgery at Our Lady's Hospital in Navan, elective surgery at the Louth County Hospital in Dundalk and outpatient clinics at Our Lady of Lourdes Hospital in Drogheda. What of the Fianna Fáil Deputies in Counties Meath and Louth? What will the Ministers, Deputies Dermot Ahern and Noel Dempsey, Deputies Johnny Brady, Thomas Byrne, and Seamus Kirk and the Minister of State, Deputy Mary Wallace, do about the cuts in their counties? That is what it comes down to, individual Deputies recognising that they are messengers of their constituents. These cuts are but a foretaste of the full implementation of the Hanly and Teamwork reports in the north east and throughout the State.

It is all a colossal fraud because to justify the cuts in hospital services and the over-centralisation of services in a few major hospitals, the Minister and the HSE repeatedly cite the key role to be played by primary care services, which they claim to be greatly improving. However, where are the more than 100 primary care centres we were promised in 2001? Far from improving, we are now facing a new crisis in primary care because of the shortage of general practitioners. The north-east region again has been the first to sound a warning, with the Irish Medical Organisation highlighting the low number of GPs and the pressure they are under. We have an ageing GP population, not enough trained GPs coming through and not enough GPs choosing to treat medical card patients. The crisis has been compounded by the HSE's refusal to fund the additional GP training places needed to bring the numbers up to the recommended 150 in 2008. The number of patients per GP in this State is too high. The present system and the Government malaise on this issue are a recipe for yet another health care crisis.

Two years ago A Vision for Change was published and it promised a new beginning in mental health services. Progress since then has been far too slow and the reality is that people with mental illness are still being badly let down by the Government. Mental health remains the most neglected sector of our health services. It is again a scandal that the Minister for Health and Children, Deputy Harney, and the HSE have failed to produce and to carry out an implementation plan for A Vision for Change. Essential improved services were promised but they are not being provided and staff are not being appointed because of the HSE recruitment embargo, as highlighted by the Irish Mental Health Coalition. While additional funding for mental health was allocated in 2006 and 2007, no additional money was provided in 2008. This is doubly damaging, as it was revealed that nearly half of the €50 million allocated in 2006 and 2007 to implement A Vision for Change was spent in other areas.

Despite all their fine words, the Government is failing to deliver for people with mental illness and it must continue to be challenged on this until A Vision for Change is fully implemented. I cited the tightening of the recruitment ban by the HSE and the damage it is doing in the area of mental health. That is true across all the front line of health care and is leading to further hardship for patients and a further lowering of morale within the health services. I could cite many other specific and pressing health issues if time allowed but I will conclude with just one. The Irish Family Planning Association revealed last month that the number of Irish women dying from cervical cancer continues to increase every year, despite the fact that this disease is entirely preventable through screening and vaccination. There is still no sign of a national screening programme in this State nor a decision on whether the vaccine is, in the Minister's own words, "cost effective". What does she mean by that? How many women's lives are worth the cost to this Government?

All I ask is that the situation is changed. I urge everyone concerned with our health services to unite in the demand for equality, excellence and the care that all our people deserve. I hope Government Deputies will accept my challenge.